Open/Lap

Hey guys.  My name's Katie and I'm new to this whole WLS process. 

I have a question for everyone, which I'm sure has been asked and answered on here numerous times but I haven't come across it.  My BMI is 54 and I'm hoping to get a lap-RNY,  I know the surgeon I'm going to see does mostly laproscopic procedures but I'm worried that my BMI is too high and they'll have to do the open, which I'm really, really trying to avoid because of the longer recovery and higher likelihood of complications. 

Wherever I look, they have different limits for what BMI constitutes "too high" for laproscopy.  Does it depend on how much weight you carry in your abdomen or do they go purely go by BMI?  I'm sure this varies greatly from surgeon to surgeon, but I'd like to hear all of your experiences. 

Hi, Katie.  You're right that there are many factors that determine whether an RNY can be done laproscopically or open.  I think you'll find many folks on this site with starting BMIs higher than yours that had their surgery lap.  My BMI was around 60, and my surgery was lap.  Your surgeon may want you to do a couple weeks of liquid protein before surgery to shrink your liver.  That can make it easier for him to do the surgery lap.  But talk to your surgeon and find out what his guidelines are.   Good luck on your continuing journey -  Kellie

Thanks so much for responding.  I wouldn't have a problem going on any sort of diet for a few weeks - my issue is much more about not gaining it back, haha.  I'm just crossing my fingers about it at this point because my first appointment is next Monday.  Good luck to you, too :o)

It depends on a lot of  factors, but the amount of experience your surgeon has with lap procedures and especially on people with higher BMIs is probably paramount.  I've been told that its safer to do it open if your surgeon's lap experience is limited.  It also does depend somewhat on where you carry your weight.  If you are pear-shaped then there is less fat in your abdomen.   My BMI was in the high 70s and my RNY was lap.  I was scared it wouldn't be, but the surgeon made me lose 40lbs on a strict no carb diet and I think that made a difference because my liver was nice and small (less glycogen because of the low-carb diet).  I also had a very experienced surgeon and although he was worried that it might be a challenging surgery, it turned out to be very easy and we were both pleased.  It only took about 50 minutes.  I am not especially pear-shaped, I amfat all over.   There are a lot of people on this board who had BMIs in your range and higher who had lap, so unless your surgeon says otherwise I don't think you need to worry too much.  And if he does think it should be open, I'd consider another surgeon.   Best of luck! Jenn

I'm pretty evenly distributed myself, which is why I'm figuring it could go either way.  I just wanted to know what I was going to be met with when I go for my first consultation.  Thanks for the info :o)

greetings katie my bmi was 66 on the day of surgery. i had my rny open, but it wasn't because of my bmi. there are many reasons why someone's surgery may or may not be done lap. i just wanted to tell you that open wasn't all that bad! if you do have to go the open route for whatever reason, it'll be okay! deb -278

I could have sworn I responded to you yesterday, weird.  Anyway, thanks for your input.  Having open surgery is better than no surgery at all, to say the least.  Glad to see everything worked out for you :o)

I didn't know that about the open procedure.  I figured the only difference was the incision.  I do hear a lot more about complications from open-RNYers, but I think that might also be because they used to all be done that way, so they may have gotten their surgeries years ago.  Thanks for your input :o)

Katie, I agree with Deb.  I had a BMI of 69 at surgery.  My surgeon favored lap and that is why I chose him over the other two in the practice.  The day of surgery he forwarned me that he might have to do open he would see once he got me in the OR.  Well, sure enough he started to drill for lap and had to go open ( I have all the scars for both open and lap).  I think my liver was enlarged and I also think that he could perform a medial RNY without any insurance complications.  I was never able to get the straight answer on that but I read between the lines and absolutely have the utmost trust in this man. The decision is not really yours if you have faith in the surgeon. You want him/her to do what is best for you.  I had no complications with the open.  Recovery time was a bit longer but I took 8 weeks off from work so I knew I was covered. Good luck to you. Jeanne